Treatment Comparison

Approximately 90% of all anal fissures can be resolved with home treatments and nitroglycerin ointment.  This is the least invasive and least expensive remedy available.  Risks associated with nitroglycerin ointment may include headaches, lightheadedness, itching and burning.

If a chronic fissure fails to respond to standard therapy, or a patient must discontinue use of nitroglycerin ointment due to headaches, however, two other options exist. Both of these methods specifically focus on relaxing the internal anal sphincter.  The difference is whether it’s temporary or permanent.

Botulinum toxin

An injection of Botox into the internal anal sphincter can improve healing by temporarily paralyzing the muscle, which lowers resting pressure and reduces muscle spasms.  Risks may include pain from the injection, infection, hematoma and temporary loss of control of gas or, more rarely, stool.

Lateral internal sphincterotomy

During a lateral internal sphincterotomy, a small incision is made in the internal anal sphincter.  Like Botox, this promotes healing by decreasing resting pressure and spasms, but the effects are permanent.  Risks may include pain, bleeding, infection and a lifelong loss of control of gas or, more rarely, stool.